Provider Demographics
NPI:1063532844
Name:KRAFT, JULIE R (RPH)
Entity type:Individual
Prefix:MRS
First Name:JULIE
Middle Name:R
Last Name:KRAFT
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1025 ZEIN CIRCLE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE VIEW
Mailing Address - State:IA
Mailing Address - Zip Code:51450-7462
Mailing Address - Country:US
Mailing Address - Phone:712-657-2853
Mailing Address - Fax:712-464-8614
Practice Address - Street 1:101 N WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:LAKE CITY
Practice Address - State:IA
Practice Address - Zip Code:51449-1723
Practice Address - Country:US
Practice Address - Phone:712-464-8811
Practice Address - Fax:712-464-8614
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17638183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA17638OtherLICENSE NUMBER